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Treating School-Age Children who Stutter: Objectives and Activities . Craig E. Coleman, M.A. & Rebecca L. Roccon, M.S. Children’s Hospital of Pittsburgh Amy L. Zerhusen, M.S. Children’s Hospital of Cincinnati. Common Misconceptions. Only number of disfluencies can be measured

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Treating school age children who stutter objectives and activities l.jpg

Treating School-Age Children who Stutter: Objectives and Activities

Craig E. Coleman, M.A. & Rebecca L. Roccon, M.S.

Children’s Hospital of Pittsburgh

Amy L. Zerhusen, M.S.

Children’s Hospital of Cincinnati


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Common Misconceptions Activities

  • Only number of disfluencies can be measured

  • Reduction of disfluencies is the only goal

  • Criteria used in articulation/phonology can be applied to stuttering (80% fluent speech)

  • Affective responses will improve on their own, as the child’s fluency improves


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Appropriate Goals Activities

  • Goals should address all aspects of the disorder, not just the number of disfluencies

  • Goals should be geared toward increasing the overall communication skills of the person who stutters

    • Is it better to speak freely and stutter or avoid situations/words that may be problematic?

  • Target the “quantity” AND “quality” of stuttering

  • Goals should be individualized


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Goals to Address Education Activities

  • Children need to be educated about stuttering (Empowerment)

  • Education helps the child deal with stuttering long-term rather than getting a “quick fix”

  • Helps the child teach others, such as their peers, about stuttering


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Goals to Address “Quality” of Stuttering Activities

  • These goals should target decreased physical tension during stuttering

  • Kids can learn that they sometimes can’t control “if” they stutter, but they can control “how” they stutter

  • Goals here should also target reduction of secondary behaviors

  • These are often stuttering modification techniques


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Goals to Address “Quantity” of Stuttering Activities

  • These goals are speech modification techniques

  • They target reduction of the number of disfluencies

  • Important to note that “quantity” and “quality” are not exclusive goals-one often ties in with the other

  • Goals should be viewed in terms of reduction, not how often children can speak fluently


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Goals for Targeting Overall Communication Activities

  • These are the most important goals because they target communication

  • Helping the child become a more effective communicator is the primary goal of treatment

  • Goals should heavily target avoidance or negative reactions to stuttering


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Getting to know your patient Activities

  • Interests

  • Motivation

  • Family dynamics


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Understanding their needs Activities

  • Is fluency their number one priority?

  • Do they have other medical diagnosis?


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Fluency Treatment Activities Activities

  • Don’t Break the Ice

  • Fluency Olympics

  • Fluency Slogan


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Don’t Break the ice Activities

  • Pictures taped on top of the ice cubes

  • Take turns giving directions

  • Use fluency shaping: Easy relaxed speech

  • Use stuttering modification: Pseudostutter


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Fluency Olympics Activities

  • “Stations” around your therapy room

  • One station outside of the therapy room

  • Varying levels of fluency shaping and stuttering modification tasks

  • Child leaves the room to complete one station


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Fluency Slogan Activities

  • Adopted VISA/MASTERCARD slogan

  • “One hour of speech therapy, $130; asking your parents to order dinner for you, getting the sandwich that you hate; feeling good about stuttering, priceless.”


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Fluency Slogan Activities

  • Brainstorm-How fluency affects the child’s life

  • Develop own fluency slogans

  • Helps to desensitize, lessen negative thoughts about stuttering


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Around the World Activities

  • Child is given an atlas

  • Child picks a location

  • Child describes location (fact or fictional)

    • Climate

    • Geography

    • Planning a trip to the location


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Example Activities

  • Jamaica

    • Climate:

      • hot, partly cloudy (e.g. 88o F / 31o C)

    • Geography:

      • Jamaica is dominated by mountains, mostly covered with lush, green forests. Blue Mountain is the highest point, at 7,402 feet.

    • Planning a Vacation

      • 7 day tour of white beaches, enjoy local Reggae music, culture, and food


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Speech Modification Activities

Climate

Easy starts (at sentence level)

Geography

Pausing and phrasing (e.g. There are / many mountains/ in Colorado)

Vacation

Target easy starts and pausing/phrasing at conversational speech level

Stuttering Modification

Climate

Pull-outs and cancellations at the word level (e.g. cold)

Geography

Target at sentence level

Vacation

Target at conversational speech level

Therapy Targets


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Other Therapy Targets Activities

  • Purposeful Stuttering

    • Climate

      • Prolongations

    • Geography

      • Repetitions

    • Vacation

      • Blocks


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Movie Review Activities

  • Child and clinician watch stuttering movie/clip

  • Clinician provides child with movie review worksheet

  • Child and clinician discuss the worksheet following the movie


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Movie Review Activities

  • 1.What did you like the most about the movie?

  • 2.What did you like the least about the movie?

  • 3.Were there any comments made by the speakers that you could relate to?

  • 4.Have you ever been teased about your stuttering?

  • If so, what did you say in response?

  • 5.If you have never been teased about your stuttering, what might you say if you were?

  • 6.How much do you know about stuttering?

    • 7.List 2 things you know about stuttering.

    • 8.List 2 things you would like to know about stuttering.


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Therapy Targets Activities

  • Questions 1 & 2

    • Target speech modification (e.g. easy starts) or stuttering modification (e.g. cancellations) in responses

  • Questions 3, 4, & 5

    • Target reactions to stuttering (e.g. feelings and emotions towards stuttering and responses to teasing)


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  • Questions 6, 7, & 8 Activities

    • Target knowledge of stuttering (e.g. facts and questions related to stuttering)


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Name That Category Activities

  • Clinician identifies category and child identifies members of that category

    • E.g. Things with wheels

      • Cars, bus, motorcycle

  • Activity can be reversed where the clinician provides the members of the category and the child then identifies the category


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Example Activities

  • Things that are round

    • Ball

    • World

    • CD

  • Things that are soft

    • Pillow

    • Stuffed animal

    • Clothing

  • Things that are round and soft

    • Cotton ball

    • Foam ball

    • Ear muffs


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Stuttering & Language Activities

  • Excellent activity for those children with co-occurring language deficits

    • Provides opportunities to practice stuttering modification or speech modification strategies across all levels (e.g. word, phrase, conversational)

    • Provides opportunities to address word finding or language formulation deficits


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Speech Modification Activities

Clinician provides the members of the category

Child identifies category, as well as, describes how the members are related

Pausing/phrasing at the phrase and/or conversational level

Stuttering Modification

Child identifies member of the category

Cancellations or pull outs at the single word level

Therapy Targets


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The Great Debate Activities

  • Have your students participate in debates with their peers--or with you

  • You can pretend that you are debating with the child to see who would make a better Class President of their school


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  • The “winner” of the debate is decided by a points system, which rewards one point for each of the following:

    • appropriate eye contact

    • speech modification or stuttering modification strategies (e.g., easy starts, pausing and phrasing, or even voluntarystuttering)

    • the content of the response.


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  • Each participant in the debate is given their own turn to answer questions. This gives them a chance to talk without being interrupted. In addition to allowing the child to work on several objectives in a natural context, this activity also promotes an awareness of time pressure and turn-taking


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Pick Your Team answer questions. This gives them a chance to talk without being interrupted. In addition to allowing the child to work on several objectives in a natural context, this activity also promotes an awareness of time pressure and turn-taking

  • Children pick five to six players from professional sports teams that they want to include on their team

  • They get to select their team name and make uniforms

  • Following the selection of players, the child is told to pretend that each person on his team now stutters


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Sample Team Rules facilitate communication on a team of players who stutter

  • Don’t tease others who are stuttering

  • If someone is teasing you, tell a coach

  • Use your speech tools

  • Maintain eye contact

  • Say what you want, even if you stutter

  • Have team meetings to learn about stuttering

  • Help people on the team if they are being teased by someone else


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Stuttering Football facilitate communication on a team of players who stutter

  • Helps children learn the facts about stuttering

  • Children can play against others who stutter or against their parents


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  • If they get the question right, they get to move up that many yards

  • If they get the question wrong, they do not advance and the other team gets their turn!

  • You can use this activity with a group of kids by dividing them into teams

  • They can discuss the questions they will ask (and determine how much each question is worth)


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Time to Share… many yards

  • What are some activities that you have found helpful with children who stutter?

  • Are there questions about specific cases?


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